Healthcare Provider Details

I. General information

NPI: 1104296474
Provider Name (Legal Business Name): CRISTAL SANCHEZ ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18411 CLARK ST SUITE 302
TARZANA CA
91356
US

IV. Provider business mailing address

13571 FILMORE ST
PACOIMA CA
91331
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-7276
  • Fax:
Mailing address:
  • Phone: 818-921-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: